How does the environment influence occupational engagement?

Our pre-registration Master’s students have been thinking about the wider impact that environment can have upon our occupations. They have been learning about the different dimensions of our environment and we tasked them to create a post with a question that would spark an interesting debate around this issue. We would welcome you to comment and join the debate!

Occupational therapy, culture and the curriculum: In thinking about the impact of environment on occupation, we were struck by how we talk about the socio-cultural environment, but that some of the negative influences of culture and institutions on occupation are hidden.  Although we think we are “culturally aware”, issues of structural racism and the way we internalise people’s attitudes about our ethnic or racial identities, for example, not wearing a headscarf to a job interview because we think it will affect people’s views of us or code-switching, are not easily seen in this analysis. This brought us to reflect on our curriculum and discuss the dominance of Western perspectives within it. So our question is: Do we need to decolonise the Occupational Therapy curriculum? 

Cultural context and occupation: We noted that in some cultures age is associated with esteem, authority and wisdom, which allowed older people to take a more active role in society through the assistance and respect of others. We also identified examples where the cultural context was unhelpful to overall occupational engagement. For instance there were some contexts in which where mental illness was interpreted as supernatural punishment or moral weakness to be punished rather than treated. (https://www.hrw.org/report/2020/10/06/living-chains/shackling-people-psychosocial-disabilities-worldwide# ) From this discussion we drew on several examples from our own direct and indirect experiences: One of us had seen individuals who had been permanently restrained because of the superstition that mental-illness and deformity were the result of divine punishment. Someone had a close family member who was pressured to stop using SSRIs because their church considered it to be incompatible with their religious interpretation.One of us knew a service user who was forbidden from engaging in educational activities because it was considered inappropriate for woman. So our question is: How does your particular cultural context help and hinder occupational engagement and performance?

Physical social environments and belonging: Your physical social environment (the social environment present in your physical space, as opposed to online), can enable or hinder your occupational engagement. We debated the question of where you are more alone, in a town of thousands of people or a village of a hundred. Or put another way, which better enables occupational engagement? When belonging to your local community, and expressing your role within a community is a core factor of your occupational identity, in which situation are you more able to fulfil this? According to Reed et al. (2010, p. 145) “occupation done with others gives a sense of connection and it is through the connection that occupation comes to have meaning”. We suggest that despite being surrounded by people in a town, you are often more isolated from your physical social environment, especially from those culturally specific events which can hold significant meaning, such as annual fete’s, street parties or Christmas light competitions. This in turn hinders your ability to engage in occupations which are meaningful to you. So our question is: Where are you more alone, in a town of tens of thousands of people or in a village of a hundred?

References: Reed, K., Hocking, C., & Smythe, L. (2010). The interconnected meanings of occupation: The call, being-with, possibilities. Journal of Occupational Science, 17, 140–149. doi:10.1080/14427591.2010.9686688

Healthcare systems and cultural integration: We are interested in looking into different perspectives of cultural inclusion across the world in different health care settings. We think it’s important to understand how different cultures are supported within practice, which enables clients to feel included. When we consider an open environment that explores culture, inclusion and diversity; the more effective our practice can be in enabling occupation through our environment. One example is the BAME community’s uptake on the Covid vaccine being less than their white counterparts. Does this issue raise the question that the NHS needs to be more inclusive; in terms of how we present information and create links with different communities. So our question to you is: How does the Health care system and structure in your country / area manage cultural integration?